[Bronchoalveolar lavage in the assessment of lung diseases]

The bronchoalveolar lavage (BAL) is a new method of low risk for the differential diagnosis of pulmonary disorders. In the BAL cells, microorganisms, and non-corpuscular components derived from the alveolar space can be investigated. The analysis of the recovered cells delivers information about the diseases. Lymphocyte predominant disorders are sarcoidosis, hypersensitivity pneumonitis, alveolitis, tuberculosis, lymphangiosis carcinomatosa and pneumoconiosis. The prognosis of sarcoidosis depends on the ratio of the T-helper and T-suppressor cells. Neutrophil predominant disorders are seen in idiopathic pulmonary fibrosis, asbestosis and collagen vascular disorders. BAL has also become an established approach to the diagnosis of infections in the immunosuppressed patients. Also tumor cells and tumor markers can be detected. Phagocytosed particles are an indication of inhaled dust. Asbestos fibres and silica are visible by light microscopy and metals are detected by x-ray energy dispersive spectrometry.